This is a question we hear from many parents. Some children have poor reading skills both in identifying words and comprehending the text, but many children are good readers, meaning good at word identification and able to read quickly, but lack comprehension. So, let’s look at what’s going on and how NACD addresses those issues and can help prevent those issues from developing. 

Reading comprehension can be broken down into two types of comprehension. There is a type needed to understand how one sentence links to another sentence. The sentences may link because pronouns were used in the second sentence to replace the proper nouns or common nouns in the first sentence. They may be linked by the relationship of two actions or two objects being identified. For example, Tommy woke up. He knew he needed to hurry. The relationship between these actions implies that Tommy is waking up in his bed and has someplace he needs to go, perhaps school. Another example would be: Tommy got his sneakers on quickly. Then he grabbed his basketball. As we read these sentences, our understanding of the vocabulary and the relationship of these words to each other starts to give us a construct for what may happen next. 

What happens when there is a word that is not understood in the sentence? Tommy awakened. He was anxious about being on time. Is there a construct of what is happening if you don’t understand a word in the first sentence? No, there is not. Let’s look at the next example. Tommy put on his galoshes as fast as he could. Then he grabbed his poncho.  Do we assume that a child will have a construct of what is happening here? Without an understanding of those key nouns, we can assume that they do not. 

So, we can see that receptive vocabulary and the relationship between words is important for that immediate “internal” comprehension of a text. 

What impacts on comprehension of a larger text? Working Memory is needed to provide a framework and hold the pieces so that a larger text, more than a few sentences, can be understood and recalled. If the text or story contains vocabulary largely understood by the child, then it is the working memory that is going to build the larger construct to hold and keep sorted all the information, sequentially and in a way that permits recall and understanding. A strong working memory is able to establish and hold the big picture while aligning the details of the narrative sequentially.

There is one more factor that impacts on comprehension in addition to vocabulary and working memory and that is sustained attention to language. If there is a break in attention to meaning as the individual is reading due to the habit of reading too quickly or due to the habit of disengaging from language too rapidly, comprehension is quickly lost. If this happens to adults or older students, they will typically realize and go back and re-read the portion that they missed. With children and some adults, however, this is not the case. So, we need a strong habit of sustaining attention to language established by strong short-term auditory memory.

Let’s look at these pieces as they relate to how NACD addresses neurological development in order. We work early on to develop a strong understanding of receptive language and word meanings and functions. We work early and continuously on building strong short-term and working memory auditorily as well as visually. We have diverse activities to address sustained and accurate auditory attention. We read to children and use audiobooks because studies have supported that listening comprehension and reading comprehension use the same neurological mechanisms. We use conceptual memory activities to work the mechanisms needed to group random words logically and to see new associations between seemingly random words. 

Reading comprehension is not just a matter of the right reading materials, the right workbook or curriculum. Reading comprehension is based on the very neurological functions that we address with our programs.

The following research article among many others, supports the findings of NACD over the decades that we have been working with children and adults on these issues.

Nicola Kate Currie, Kate Cain, Children’s inference generation: The role of vocabulary and working memory, Journal of Experimental Child Psychology, Volume 137, 2015, Pages 57-75.

Reprinted by permission of The NACD Foundation, Volume 40 No. 1 , 2026 ©NACD

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Our interesting times continue on. Through the past year both nationally and internationally we have heard a lot of rhetoric regarding education. A year ago, there was a lot discussion regarding excessive screen time, but “education” for many of our children this past year meant being home and sitting in front of a computer screen all day. There was also a lot of talk about how important it was for the children to be back in the classroom, to get back to how things were. What we didn’t hear mentioned was that prior to the pandemic our children were not generally receiving good or even fair educations, and that most of our children with learning problems or special needs were receiving what can only be described as pretend educations.

According to studies the average American reads at a 7^th-8^th grade level¹; and to gain a little perspective, of 79 countries, the U.S. ranks 9^th in reading and 31^st in math²; and U.S. scores have been flat for two decades. Not too impressive.

Parents, consider taking charge and assuming the responsibility for your child’s development and education.

Targeted home-based education, not packaged, curriculum-heavy homeschool programs can take less time per day than many children spend on homework, and at the same time address and work to eliminate most learning problems, dyslexia, etc. For those children with special needs, it allows time daily for targeted developmental/therapeutic intervention, as opposed to the pretend short visit with a therapist once or twice a week while at school.

Outcomes are determined by the opportunities our children receive. Who’s responsible?

References

1. https://www.wyliecomm.com/2020/11/whats-the-latest-u-s-literacy-rate/#_ftn5
2. https://www.usatoday.com/story/news/education/2020/02/28/math-scores-high-school-lessons-freakonomics-pisa-algebra-geometry/4835742002/

Reprinted by permission of The NACD Foundation, Volume 34 No.5, 2021 ©NACD

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According to the Yale Center for Dyslexia and Creativity, “Dyslexia affects about 20% of the population and represents 80-90% of those with learning disabilities.” We are talking about as many as 62 million children and adults!

What is “dyslexia?” It’s a developmental reading problem.

Did you know that virtually every child under five could be called “dyslexic” if you tried to teach most of them to read with the same techniques that are used with first and second grade children? The vast majority of children under five have not developed neurodevelopmentally to the point that they can:

• hear/differentiate similar vocal sounds as well as needed to use phonics
• sequentially process a series/sequence of sounds/phonemes
• sequentially process a series/sequence of symbols well
• mentally hold together and manipulate a series/sequence of sounds/phonemes that would permit them to construct a word

In addition, many children under five also have not developed to the point that they have organized their brains such that they have developed a dominant hemisphere, also referred to as the language hemisphere (spoken and written) and are not even sure which hand they should be using. This lack of hemispheric dominance is also what produces reversals (Is it a “b” or a “d”?), which just contributes to the problem.

Logically, if most children under five share the same characteristics as older children labeled as “dyslexic” and would have the same problem learning to read as do the older children that have “dyslexia,” then it follows that “dyslexia” is a developmental problem that can be addressed. It’s not a mystery and it’s not incurable.

For decades millions of parents have seen their children struggling with reading and have ended up having them diagnosed with dyslexia. Generally when they pushed for an explanation and a plan, they were met with the impression that their child had a mysterious, incurable disease and was doomed to having a life long problem, but they would make accommodations for them. But prior to “dyslexia” being widely used as an administrative label, children with reading issues or related problems were perceived simply as typical kids who for some reason were not doing well with reading as it was being taught. Essentially, the uniqueness of each child was perceived as part of who we are; and that we are different; and in the case of reading, some develop differently and at different rates, and some needed different approaches. If the perception was that Johnny was “normal” and had a problem with reading, then his specific problem needed to be identified and addressed.

As special education took root around the country, administratively it became necessary to identify, then label children so that they could receive special placement, have different expectations placed on them, or so that they could receive special services. Once labeled, the door was open for the local school system to receive extra state and even federal funding. Thus all the children who previously simply had a reading problem became children with dyslexia. The result was that the child who had previously been seen as normal now became a child with a mysterious disease—dyslexia. To compound the problem, the disease/label model directly or indirectly implies that everyone with the disease has the same problem, which implies the same solution or cure. If a common cure can’t be found, then no treatment is perceived as valid, as has happened with those labeled as having ADD or ADHD. In the case of ADD and ADHD, when everyone with the “disease” is perceived as having the same problem with a mysterious cause, and if there is then not a universally successful treatment, then the answer is to retreat to a drug. It’s not too surprising that if you look at the list of symptoms used to diagnose ADD, it reads like the description of virtually every three or four year old child: short attention span, distractible, impulsive. As with children labeled with ADD and ADHD, children labeled as dyslexic or who have a learning problem share many of the same developmental issues as younger children. The origin of the problem is usually various issues associated with neurodevelopment. That which is developmental changes, and what changes can be developed. There are solutions.

The answer to the question of why can’t Johnny read changed from, “We need to find the technique that works for him and the root of the problem” to simply, “Johnny can’t read because he’s dyslexic.”

Essentially the term dyslexia means that there is a reading problem. When the “problem” was first identified, it was done so by a German ophthalmologist, an eye doctor who viewed the problem as word blindness. Up until into the sixties, dyslexia was largely categorized as a visual problem that was identified primarily by reversals. Children had difficulty distinguishing between a “b” and “d” or “saw” for “was.” Surprise, many four year olds confuse “b’” and “d” and have reversals. These reversals were, and in reality are still today, perceived as a bit of mystery by most, but are really the reflection of the level of neurodevelopmental organization. The child is young and the brain has not reached a level of organization that has permitted the development of a dominant hemisphere. The recognition that visual issues were involved in dyslexia also led to the belief that the root cause was an issue with visual tracking and convergence. It has been recognized that such visual problems may exist in children with and without dyslexia, but it is not the cause.

Today dyslexia is primarily viewed as an auditory/phonological problem, not a visual problem, because most children are now being taught reading with an auditory/phonological approach–phonics. The trend in perception of dyslexia as being primarily a visual, as opposed to auditory, problem were based on the predominant reading approach at the time.

Elimination of dyslexia can be as simple as using a different approach to reading; but ideally we will identify any of a variety of underlying developmental issues, which once identified are usually fairly easy to remediate. *

When folks ask us at NACD about dyslexia, we tell them that we refer to those who come to us with dyslexia as the “easy ones.”

*Neurologically and functionally there can actually be some advantages to having “dyslexia,” particularly once the actually reading issues have been addressed. When working with specific unique whole children, we can identify their individual issues and their individual strengths and work to help them become successful and even take advantage of some of their uniqueness.

Reprinted by permission of The NACD Foundation, Volume 33 No. 6, 2020 ©NACD

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For many children and young adults with whom we work, it is summer. For our families in the Southern Hemisphere school has recently resumed, but there will be those rather long school breaks. Parents often question what to do with these “breaks” and vacation times so that they really feel like fun and are rejuvenating.

There are some very basic rules here. If you stop doing something and your child rapidly forgets what they have learned, then that isn’t a good idea. When you resume working with your child, you will find that you then have to waste a lot of time reteaching what they had already learned before the break. Whether it is mobility, vision, speech, cognition or academics, if you are going to lose ground, don’t skip the activity! This applies most obviously to math. Reading is also an area, with our beginner readers in particular, where if you don’t use it you lose it. Having to start all over again with math or reading is really discouraging.

If you just moved up in processing or knee walking, crawling or creeping don’t stop now! Mobility can be done anywhere as long as you have a few things that you might need, a yoga mat, a blanket, an incline or a beach, there are ways to adapt to get these critical activities done without just staying home.

The most portable activity of all time is auditory processing. This take-anywhere, do anytime activity can just be rolled in with whatever is going on as long as the child is awake and alert. Get your inspiration from your environment. Whether it is numbers and letters from car license plates or colors you see in the woods around you, objects they can see at your vacation spot, or ingredients in your special meals, processing is adaptable.

So how do we make this work so that the children don’t feel like they are missing all the fun, and we are gaining improvements and not sliding backwards? Actually, it is really easy. We input review information quickly. We ask for brief output and we keep moving. This works well with math and sight words. It is fast and fast is pretty fun.

With my granddaughter, I love to show her a word card just for a moment and take it away. It always makes her laugh and she almost always gets the word correct after thinking for a minute. There are many ways to turn these fast reviews into play. We’ve had parents who had the children bounce a ball on a word and say it or squirt a water gun at a word the parents asked them to find. Words are portable, so take them wherever you go.

Reading is a fantastic activity whether you are reading to your child or he or she is reading with or to you. If you are traveling, you can read about where you are going. If you are enjoying a holiday, you can read about that. Funny books are great for breaks, funny poetry books or joke books are great for breaks as well. Reading books that you, the parent, love will make the summer or holiday more special for you and your child. Nothing makes a trip better than books on audio so don’t forget those!

Many parents and children agree that math is definitely not fun. Fortunately, there are plenty of math fact games and math operation games that make output a bit more interesting. I have had several parents do a very high-intensity strategy with math facts and greater than or less than. Using some very valued food snacks, the child is presented with either a math fact or a greater than or less than question. If the child gets the wrong answer, the parent eats some of the snack, if the child is correct, he or she gets to eat the snack. That’s high intensity.

When there are program activities to be done that don’t lend themselves to fun, check with your coach for ideas and also look at getting much of the program done early in the day, leaving the rest of the day to feel more like leisure time. During those times look for opportunities to do things you don’t normally do or go places that you don’t typically go. Uniqueness and novelty are good for all of us. It engages our attention, stops rumination and opens up opportunities for wonder and discovery.

I often hear parents refer to program as work. In many ways it is work for us and for the children. I would like you, however, to present it as an opportunity rather than work. It is an opportunity to win, to do something better today than you have ever done it before now. It is an opportunity to have a reason to celebrate. It is an opportunity to reach a goal that you have set. If we want children and young adults to feel empowered, we help set very short-term goals that are reachable. Each time a goal is reached, it reinforces to the child and to you that this progress is something you can achieve.

Today I talked with a mom whose child followed a one-step verbal direction that she had never been given before and this was a huge triumph. This turning point with a child demonstrating an understanding of language and a verbal direction for the first time was achieved through months of effort and determination. It was a victory and opens the door to many other victories to come. The brain is able to change through, you know the line, frequency, intensity and duration of the right input. So, it is not about breaks but about input.

There is another key feature of vacations and holidays, they offer opportunities to show off to other people. Whether your child is showing that he can now creep to his cousins or showing his grandmother how he can pick picture cards, read sight words or name things in a book, this is a wonderful opportunity for your child to get some high intensity, positive feedback and encouragement. It will do you good too as it rewards you to show others the gains that your child is making.

Childhood and young adulthood are wonderful times and we all have great memories of our summers and our holidays. Let us help you adapt what needs to continue to be done to suit your situation. After all, your child and your family are unique, and we endeavor to adapt the program to that uniqueness. We also have decades and decades (in my case decades, decades, and decades) of experience making program activities efficient, effective and often quite fun.

We share your impatience for success and improvement. In order to achieve this, we need continuity of input for sure. This input can often be done quickly. This input is often portable, and this input can sometimes be done while doing other things. So do not feel that you must either abandon your program entirely because you are on a break or struggle through it the same way you have always done. We are really here to help, just an email away. We have not only our own ideas and suggestions, but also the many, many great ideas that parents have shared with us over the years.

Summer breaks and holiday breaks are wonderful times when we can spend more time together as a family doing fun and relaxing things. Working together, we can help you find ways to incorporate what needs to get done with the things you hope to do. I encourage you to share your summer and holidays with us by posting on our Facebook page about your progress, your fun times and your wonderful child. Please stay in touch with your coach so that we can help make this your best summer or break ever.

Reprinted by permission NACD Newsletter, June 2019 ©NACD

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It appears that middle ear fluid (otitis media with effusion) is a significant problem for children with Down syndrome. Our experience at NACD with literally thousands of children with Down syndrome indicates that middle ear fluid issues are ubiquitous and are of tremendous concern relative to the global development in this population.

For forty years NACD at any given time is working with approximately 300 children and adults with Down syndrome from all over the world. We work with the “whole” individual and look for correlations between issues to determine how to best address problems and global development.

One of the ongoing issues affecting overall medical care and therapeutic intervention, particularly as is it impacts children with developmental issues and complex interdependent issues, is the compartmentalization of the care. At NACD we are acuity aware of the importance of working with the “whole” child. Looking at isolated pieces can lead to ongoing issues that can have very significant impact on the child’s development and could possibly be remediated if the need were perceived based on the totality of the impact.

When looking at the “whole” child, it is possible to identify discrepancies in development. Development in children with Down syndrome typically follows “normal” development. This development, albeit slower than normal, follows the same patterns and exhibits the same associated developmental pieces as ‘typical” children. In areas where there are inconsistencies in the development of associated pieces, it is necessary to identify underlying cause. Often when language is delayed more than other areas, the underlying cause is something that is adversely affecting the hearing.

When dealing with a problem such as middle ear fluid, we want to address cause when possible. Mucus and congestion are virtually synonymous with middle ear fluid. It would appear that we could avoid at least part of the fluid problem by more aggressively addressing the cause of mucus. Many children have allergies that can be treated, but mucus-producing foods are in most every child’s diet. It would appear that if we could eliminate dairy and gluten from our children’s diets, we would probably go a long way toward avoiding or mitigating these issues.

Children with DS have anatomical issues that increase the prevalence of middle ear fluid. These issues include large adenoids, small nasopharynx, impaired swallowing, and narrow and abnormally horizontal Eustachian tubes. These anatomical issues, coupled with the fact that children with DS tend to have excessive mucus and excessive earwax, further complicates the problem. Middle ear fluid issues often resolve themselves in typical children; but the anatomical issues associated with DS make this substantially more difficult.

One of the issues that appears to create problems for children with DS is that middle ear fluid, even if considered in the “normal” range based on tympanic testing, can still have a significant impact on the hearing and development of this population. Over the course of decades, we have seen numerous cases where at parents’ insistence tubes were inserted even though tympanograms indicated that fluid was still within “normal” ranges.¹ Following many of these procedures the doctors commented after the procedure that there was much more fluid than expected. It appears that for the majority of children with DS having received tubes, even when the need based on the exams and testing was questionable, there were virtually immediate positive changes in language development. I leave it to the ENTs (otolaryngologists) to research and determine if different testing, norms, or criteria are needed. This is clearly an area requiring further investigation.

Complicating the issue as to whether or not to place tubes is the issue of what level of baseline testing is needed. Often children will have a flat tympanograms, and the doctor’s recommendation is to wait two, four, or even six months to repeat the testing. For a child, particularly a child with delayed language and cognitive development, two months or more can have tremendous impact on the child’s future development. If the doctor wishes to be cautious, repeat the tympanogram in two weeks. One might also consider the child with chronic congestion who will have some degree of associated chronic middle ear fluid. Why not in such cases insert tubes to assist with the mechanics and help drain the fluid? When this issue is seen relative to its global impact on the development of the child with DS, I believe aggressive treatment can be justified. Tubes would appear to be a relatively simple, inexpensive, benign treatment that can have significant, if not dramatic, impact on a child’s development and future.

To understand the significance of this issue, let’s look at developmental issues that can result from perhaps even a moderate issue with middle ear fluid.

Middle ear fluid issues have a negative developmental impact on numerous foundational developmental issues including:

• Hearing

• Receptive language development

• Expressive language development

• Speech/articulation

• Auditory sequential processing, short term memory, working memory, and cognitive development

• Attention

• Reading

• Balance, mobility, walking

• Visual tracking, convergence, strabismus

Hearing

Hearing involves sound waves moving into and through the outer ear and impacting the eardrum. The sound waves vibrate the eardrum, which in turn produces movement of the three small bones of the middle ear. The middle ear is a cavity containing air that should have the same atmospheric pressure as that outside the body. The pressure is regulated by the Eustachian tubes, which go from the middle ear to the upper part of the throat. The sound waves then produce vibrations on the oval window that then transmits the vibrations to the fluid in the inner ear, which in turn stimulates the hair cells of the cochlea, transforming the vibrations into nerve impulses that enter the acoustic nerve and then the brain. It is the brain that actually interprets the information and “hears” the sounds or words.

One of the immediate issues with middle ear fluid is resulting hearing loss. Numerous studies have equated hearing loss in DS to middle ear fluid. ^2,3 Conductive hearing loss, which is common in DS, is usually caused by middle ear fluid, but can also be caused by excessive wax.

Receptive Language Development

Receptive language refers to the ability to understand language. Every child begins learning to understand language by hearing specific words in association with specific objects or events with sufficient frequency, intensity, and duration. The consistency of this input is imperative for the child to literally learn to hear and understand. A completely deaf child receives none of this auditory input; a child with a hearing loss receives poor input; and a child with inconsistent input resulting from variations in middle ear fluid receives often less than the necessary quality of input needed for receptive language development. Receptive language is the first step in the development of expressive language, speech, and cognition.

Expressive Language Development

Expressive language/talking has been historically one of the biggest concerns for children with DS. Sometimes those not understanding the foundational issues will out of vexation resort to sign language or augmentative communication to facilitate communication and avoid frustration. Lack of function should not be perceived as a lack of potential or inherent ability to develop that function. If a child with DS is not talking, there is a reason that needs to be identified and addressed. Rarely do children with DS have oral motor issues or apraxia to such a degree that it prohibits the development of basic language, even though such issues can affect the speech. Significant delay in the development of language in a child with DS is virtually always a reflection of an issue with hearing or inconsistent hearing.

Speech/Articulation

Developmentally we refer to speech/articulation as the production and clarity of speech. A significant component of speech is oral motor function, which is a very common issue with children with DS. However, you cannot reproduce what you cannot hear. Middle ear fluid issues can produce issues with learning to process specific frequencies of sound. If you cannot hear, or if your brain does not learn to hear, a specific frequency, then it can’t be reproduced. Case in point, there is not an “r” sound in Japanese, and even for a native Japanese speaker who becomes fluent in English, the “r” sound may be next to impossible to learn because when their brains were learning to hear, the opportunity to hear that sound did not exist. Repeating the word “rice” typically comes out as “lice,” regardless of the number of times they hear the word spoken correctly. Audiograms, which only measure typically six frequencies, do not identity very specific frequency issues. We have used voice analysis to gain a better understanding of specific frequency issues and have discovered that they are extremely common. I would like to see research directed at seeing whether voice analysis could be used to accurately assess hearing more specifically and objectively than an audiogram or in conjunction with and audiogram.

Auditory Sequential Processing, Short Term Memory, Working Memory, and Cognition

Language and the development of language is primarily a reflection of the development of auditory sequential processing. Expressive language will not exceed the ability to sequentially process, hold, and mentally manipulate auditory information. Auditory sequential processing/short term memory is measured in pieces of auditory information that can be processed in a sequence or chain. This is often tested and measured by how many numbers you can hear presented in a sequence at one-second intervals. It could also be measure by the ability to listen to and repeat random words also heard at one-second intervals and repeated or how many simple directions one can hear in a sequence and then carry out. Generally, a child who can follow one simple direction will use random isolated words, working into functional use of individual words. As the child moves into being able to follow two-step directions, they will begin using two and then three-word phrases. When they can sequence three pieces, they will start using four, then five words in a sentence. As their auditory sequential processing increases, so does their receptive and expressive language.

The foundation of working memory, which is now appropriately being called the new IQ, is built upon the short-term memory. Working memory essentially represents complexity of thought and is reflected in global maturity and executive function. All of this put together represents cognition, which is simply that which permits us to learn, think, and communicate.

Issues affecting hearing in the first few years can have a negative impact on the development of all of these critical pieces, an impact that may not be able to be entirely remediated, or which requires years of extensive specific targeted intervention.

Attention

Over six million children have been diagnosed with the mysterious “disease” of ADHD, which is termed as a mental disorder, rather than a developmental disorder. Perhaps this delineation is based on a perception that a mental disorder can be treated with drugs, as opposed to a developmental issue that cannot. I believe that one of the most common issues affecting attention is auditory sequential processing and that one of the primary causes of auditory processing issues is recurrent middle ear fluid in children. The inconsistencies in hearing adversely affect the child’s ability to attend to and process language, resulting in slow or underdeveloped auditory development, including auditory sequential processing. Negatively impact auditory processing and you subsequently negatively impact auditory short-term memory, auditory working memory, executive function, and global maturity. The term ADHD is at times used as a secondary or dual diagnosis for those with Down syndrome and other developmental problems, but the symptoms that result in this label exist in every child with a developmental cognitive delay. It is questionable at the very least to ignore the cause or causes and needed developmental intervention by attempting to mask the symptoms with medication.

Reading

Learning to read can be very negatively impacted by even minor hearing or specific auditory tonal processing issues. Teaching reading using an auditory tonal and auditory sequential processing approach, such as phonics, is often disastrous for those with Down syndrome because of their auditory issues. However, children taught reading through a more visually based sight word approach do much better. A visually weighted word attack approach still has a significant auditory component. Issues with auditory tonal and sequential processing have a negative impact regardless of the reading approach, but significantly less of an effect with a sight-reading foundation.

An additional issue relating middle ear fluid and reading is the role of the vestibular-ocular reflex in reading and writing. The vestibular-ocular reflex is a reflex that associates activation of the vestibular system and eye movements. Any interference in this reflex adversely affects the ability to maintain focus. There is almost constant slight head movement when one is reading or writing. Interference in the vestibular-ocular reflex negatively impacts the compensatory eye movements that permit the child to sustain focus.⁴

Balance, Mobility and Walking

Walking has a profound effect on neurological development and is associated with language and cognitive development. Children with DS often have issues with tactility, muscle tone and strength that can delay and or complicate gross motor development and walking. These issues are only compounded if the development of balance is compromised. Middle ear fluid has a negative impact on the inner ear’s balance/vestibular system, as well as the vestibular–ocular reflex, further complicating the development of balance, depth perception and thus walking.⁵

Visual Tracking, Convergence, and Strabismus

The vestibular system plays a significant role in the development of ocular control, tracking, and the development and severity of strabismus. The vestibular system as mentioned previously affects the movement and control of the extraocular muscles that are responsible for visual tracking and which need to work in concert to keep the two eyes working together.

It is not unusual to see children with DS suddenly develop a strabismus or to see it suddenly get worse.⁶ When we become aware of these issues, we suggest that the family visit their ENT first, not their optometrist or ophthalmologist, because the most likely cause of the issue is middle ear fluid. Strabismus, which is a misalignment of the eyes, can take many forms, but generally the family will observe one eye or the other going in toward the nose or out toward the ear. If a strabismus exists the child is unable to perfectly align the eyes together, with a resulting loss of depth perception. It would appear that even slight issues with middle ear fluid could have a negative impact on ocular control and a negative impact on a wide range of functions. 

Conclusion

Seen in isolation some degree of middle ear fluid may not appear to be of great significance. However, in viewing the global aspects of middle ear fluid we have an issue that can have wide ranging and significant impact on a child’s future development.

We urge parents and professional to be vigilant and to address ear fluid aggressively. Remediation of issues associated with middle ear fluid generally requires targeted, vigorous, dynamic, and coordinated intervention.

References

1. Ear Center: Ear Tubes (Bilateral Myringotomy & Transtympanic Tubes)
   http://www.earcentergreensboro.com/medical-education/ear_tubes.php
2. Otitis media with effusion with Down syndrome
   Int J Pediatr Otorhinolaryngol. 2013 Aug;77(8):1329-32. doi: 10.1016/j.ijporl.2013.05.027. Epub 2013 Jun 20.
   In this study one in three eight-year-old children with DS had current middle ear fluid and had verified hearing loss.
3. Balkany, T.J., Mischke, R.E., Downs, M.P. & Jafek, B.W. (1979). Ossicular abnormalities in Down’s syndrome. Otolaryngology: Head and Neck Surgery, 87, 372-384. Middle ear fluid issues account for 83% of hearing loss in children with DS
4. The influence of eye movement and the vestibular-ocular reflex in reading and writing. Rev. CEFAC vol.16 no.6 São Paulo Nov./Dec. 2014 http://www.scielo.br/scielo.php?pid=S1516-18462014000601791&script=sci_arttext&tlng=en
5. The effect of otitis media with effusions on balance in children. Clin Otolaryngol Allied Sci. 2004 Aug;29(4):318-20. https://www.ncbi.nlm.nih.gov/pubmed/15270815
6. Ophthalmic complications of otitis media in child J AAPOS. 2011 Jun;15(3):272-5. doi: 10.1016/j.jaapos.2010.12.018.ren https://www.ncbi.nlm.nih.gov/pubmed/21777800

Reprinted by permission of The NACD Foundation, Volume 31 No. 9, 2018 ©NACD

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A newly published study explored the effects of reading to your child versus having them use other media, such as watching a cartoon or listening to an audiobook.

“In a single generation, the explosion of screen-based media has transformed the experience of childhood, from TV and videos, to an unlimited range of content available at any time via portable devices that can be challenging to monitor,” said Dr. John S. Hutton, one of the authors of the study. “The emergence of these technologies has far outpaced our ability to quantify its effects on child development, human relationships, learning and health, fueling controversies among parents, educators and clinical providers…” Hutton is a researcher and pediatrician at the Cincinnati Children’s Hospital where he studies the processes of learning how to read.

In the study, 27 children, each around age 4, were observed in an FMRI machine. They were given the stories three different ways: audio only; the illustrated pages of a storybook with an audio voiceover; and an animated cartoon.

Using only audio, the language parts of the brain were activated, but there was less overall interaction. There was evidence the children were not fully understanding the information.

With the cartoons (animated images with audio), there was a lot of brain activity and perception, but not a lot of interconnectivity between the various types of processing. “The language network was working to keep up with the story,” says Hutton. “Our interpretation was that the animation was doing all the work for the child. They were expending the most energy just figuring out what it means.” Comprehension of the story was found to be the least effective when viewing the cartoons.

When shown illustrations along with being read the story, instead of only paying attention to the words, the children’s comprehension of the story was helped by the illustrations. “Give them a picture and they have a cookie to work with,” he explains. “With animation it’s all dumped on them all at once and they don’t have to do any of the work.”

In the illustrated book version of the test, researchers noted better connectivity between all the brain networks: visual, imagery, language and more.

Reading to children seems to have the added effect of stimulating their imagination more as they attempt to “fill in the blanks” between the audio and the simple illustrations. If their language and auditory processing development is not yet developed or is falling behind, it may be that reading to them using a book with illustrations will help them keep up and comprehend better.

The overall implication of the study appears to show that for kids who have a hard time keeping up with the auditory and visual information coming in with an animated cartoon, may be helped by using the illustrations to form a better mental picture of what they are reading and hearing. Not to mention the physical and emotional bond that is formed by reading to your child.

While it’s not always possible to read to your child and certain cartoons can be stimulating and also educational, mixing in some one-on-one reading time using books with illustrations can be an effective way to build your child’s visual and auditory processing.

Sources

NPR.org – Learning & Tech – What’s Going On In Your Child’s Brain When You Read Them A Story? by Anya Kamenetz – May 24, 2018

Assessment of Screen-Based Media Use in Children: Development and Psychometric Refinement of the ScreenQ – John Hutton, Jonathan Dudley,Tzipi Horowitz-Kraus, Thomas DeWitt, Scott Holland

The post NACD Science Corner Vol. 13 – Is Reading to Your Child Better Than Using Other Media? appeared first on NACD International | The National Association for Child Development.